Carl L. von Baeyer

The attributional Style Questionnaire

Of current interest are the causal attributions offered by depressives for the good and bad events in their lives. One important attributional account of depression is the reformulated learned helplessness model, which proposes that depressive symptoms are associated with an attributional style in which uncontrollable bad events are attributed to internal (versus external), stable (versus unstable), and global (versus specific) causes. We describe the Attributional Style Questionnaire, which measures individual differences in the use of these attributional dimensions. We report means, reliabilities, intercorrelations, and test-retest stabilities for a sample of 130 undergraduates. Evidence for the questionnaires validity is discussed. The Attributional Style Questionnaire promises to be a reliable and valid instrument.

The Faces Pain Scale – Revised: toward a common metric in pediatric pain measurement ☆

&NA; The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self‐report measure used to assess the intensity of childrens pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self‐rating and observational scales which use a common metric (0–5 or 0–10). Using a computer‐animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six‐face Faces Pain Scale – Revised (FPS‐R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5–12 years. In the third phase, a clinical sample of pediatric inpatients aged 4–12 years used the FPS‐R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non‐surgical painful conditions. The validity of the FPS‐R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS‐R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS‐R and either of the analogue scales. The FPS‐R is shown to be appropriate for use in assessment of the intensity of childrens acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0–10), and conforms closely to a linear interval scale.

Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations

UNLABELLED Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 26 professionals from academia, governmental agencies, and the pharmaceutical industry participated in a 2-stage Delphi poll and a consensus meeting that identified core outcome domains and measures that should be considered in clinical trials of treatments for acute and chronic pain in children and adolescents. Consensus was refined by consultation with the international pediatric pain community through announcement of our recommendations on the Pediatric Pain List and inviting and incorporating comments from external sources. There was consensus that investigators conducting pediatric acute pain clinical trials should consider assessing outcomes in pain intensity; global judgment of satisfaction with treatment; symptoms and adverse events; physical recovery; emotional response; and economic factors. There was also agreement that investigators conducting pediatric clinical trials in chronic and recurrent pain should consider assessing outcomes in pain intensity; physical functioning; emotional functioning; role functioning; symptoms and adverse events; global judgment of satisfaction with treatment; sleep; and economic factors. Specific measures or measurement strategies were recommended for different age groups for each domain. PERSPECTIVE Based on systematic review and consensus of experts, core domains and measures for clinical trials to treat pain in children and adolescents were defined. This will assist in comparison and pooling of data and promote evidence-based treatment, encourage complete reporting of outcomes, simplify the review of proposals and manuscripts, and facilitate clinicians making informed decisions regarding treatment.

Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years

Abstract Observational (behavioral) scales of pain for children aged 3 to 18 years were systematically reviewed to identify those recommended as outcome measures in clinical trials. This review was commissioned by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (www.immpact.org). In an extensive literature search, 20 observational pain scales were identified for review including behavior checklists, behavior rating scales, and global rating scales. These scales varied in their reliance on time sampling and inclusion of physiological items, facial and postural items, as well as their inclusion of multiple dimensions of assessment (e.g., pain and distress). Each measure was evaluated based on its reported psychometric properties and clinical utility. Scales were judged to be indicated for use in specific acute pain contexts rather than for general use. Two scales were recommended for assessing pain intensity associated with medical procedures and other brief painful events. Two scales were recommended for post‐operative pain assessment, one for use in hospital and the other at home. Another scale was recommended for use in critical care. Finally, two scales were recommended for assessing pain‐related distress or fear. No observational measures were recommended for assessing chronic or recurrent pain because the overt behavioral signs of chronic pain tend to habituate or dissipate as time passes, making them difficult to observe reliably. In conclusion, no single observational measure is broadly recommended for pain assessment across all contexts. Directions for further research and scale development are offered.

Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children's self-reports of pain intensity.

ABSTRACT Despite wide usage of the Numerical Rating Scale (NRS) for self‐report of pain intensity in clinical practice with children and adolescents, validation data are lacking. We present here three datasets from studies in which the NRS was used together with another self‐report scale. Study A compared post‐operative pain ratings on the NRS with scores on the Faces Pain Scale‐Revised (FPS‐R) in 69 children age 7–17 years who had undergone a variety of surgical procedures. Study B compared post‐operative pain ratings on the NRS with scores on the Visual Analogue Scale (VAS) in 29 children age 9–17 years who had undergone pectus excavatum repair. Study C compared ratings of remembered immunization pain in 236 children who comprised an NRS group and a sex‐ and age‐matched VAS group. Correlations of the NRS with the FPS‐R and VAS were r = 0.87 and 0.89 in Studies A and B, respectively. In Study C, the distributions of scores on the NRS and VAS were very similar except that scores closest to the no pain anchor were more likely to be selected on the VAS than the NRS. The NRS can be considered functionally equivalent to the VAS and FPS‐R except for very mild pain (<1/10). We conclude that use of the NRS is tentatively supported for clinical practice with children of 8 years and older, and we recommend further research on the lower age limit and on standardized age‐appropriate anchors and instructions for this scale.

Children’s Self-Reports of Pain Intensity: Scale Selection, Limitations and Interpretation

Most children aged five years and older can provide meaningful self-reports of pain intensity if they are provided with age-appropriate tools and training. Self-reports of pain intensity are an oversimplification of the complexity of the experience of pain, but one that is necessary to evaluate and titrate pain-relieving treatments. There are many sources of bias and error in self-reports of pain, so ratings need to be interpreted in light of information from other sources such as direct observation of behaviour, knowledge of the circumstances of the pain and parents’ reports. The pain intensity scales most commonly used with children – faces scales, numerical rating scales, visual analogue scales and others – are briefly introduced. The selection, limitations and interpretation of self-report scales are discussed.

Children's self-report of pain intensity: What we know, where we are headed

The present paper provides a short, practical introduction to children’s self-report measures of pain intensity, followed by an overview of principles and issues. Details on individual self-report scales were previously reported in a landmark systematic review in 2006 and will not be repeated here. Broader measurement issues discussed here include interpretation of pain scores over time, across individuals and in relation to contextual factors; special considerations affecting children younger than six years of age; social communicative functions of pain reports; cognitive developmental factors in understanding pain scales and their anchors; screening for the ability to use self-report scales and training for children who do not have this skill; level of measurement (interval versus ordinal); estimating clinically significant change for groups and individuals; and measurement of aspects of pain other than intensity. Also highlighted are areas in which there has been progress and a lack of progress since the last time this topic was featured at the International Forum on Pediatric Pain in 1996. The present article closes with an outline of key areas for further research on children’s self-report of pain and a brief summary of recommendations for clinicians.

Invalid use of pain drawings in psychological screening of back pain patients

Abstract Drawings by low back pain patients depicting the severity, type and location of their pain have been suggested as a brief screening technique for psychological involvement in the pain complaints. A study of 212 back pain patients showed that pain drawings cannot validly be used in this way, since over half of the patients meeting MMPI criteria for psychological involvement in their pain were incorrectly identified as normal on the Pain Drawing test.

Cognitive-behavioural predictors of children's tolerance of laboratory-induced pain: implications for clinical assessment and future directions.

This study sought to investigate cognitive-behavioural predictors of childrens tolerance for laboratory-induced cold-pressor pain. It was hypothesised that pain tolerance, as measured by immersion time, would be greater in children who were high in self-efficacy for pain, high in self-reported use of cognitive-coping strategies, and low in emotion-focused coping strategies such as catastrophising. Age and sex differences were also examined in post hoc analyses. Children between the ages of 7 and 14 years (N = 53) participated in the study. Offering partial support for the hypotheses, use of cognitive distraction was found to be associated with greater pain tolerance, while use of internalising/catastrophising was associated with lower pain tolerance. Older boys tended to have greater pain tolerance than younger boys, whereas younger and older girls had intermediate pain tolerance levels. Self-efficacy for pain, in general, was found to be positively correlated with age. The results support efforts to identify children who, because they have lower confidence or lower skills in coping with distress, may need extra support and preparation for painful procedures. Further research is needed to investigate these findings within a clinical pain context.

Numerical rating scale for self‐report of pain intensity in children and adolescents: Recent progress and further questions

Until very recently there has been an anomaly in the assessment of the intensity of pediatric pain. The most commonly used self-report scale is the one that, up to now, has had the smallest amount of supportive research. This scale, the numerical rating scale (NRS), is administered by asking patients to say a number, usually from 0 to 10, to express the intensity of their pain. Compared with well-known published scales such as the Faces Pain Scale – Revised, Wong-Baker FACES Pain Rating Scale, Oucher, Coloured Analogue Scale, and Pieces of Hurt, the NRS has the great advantage of requiring only a verbal interaction between the clinician and child, without the necessity for paper or plastic materials which can raise concerns about purchase, storage, distribution, and infection control. The NRS is well established with adults (Dworkin et al., 2005). However, very few studies before 2009 have reported using the NRS with children and adolescents, or have provided data supporting the use of this scale. Stinson et al. (2006), in their landmark systematic review of self-report measures, wrote:Until very recently there has been an anomaly in the assessment of the intensity of pediatric pain. The most commonly used self-report scale is the one that, up to now, has had the smallest amount of supportive research. This scale, the numerical rating scale (NRS), is administered by asking patients to say a number, usually from 0 to 10, to express the intensity of their pain. Compared with well-known published scales such as the Faces Pain Scale – Revised, Wong-Baker FACES Pain Rating Scale, Oucher, Coloured Analogue Scale, and Pieces of Hurt, the NRS has the great advantage of requiring only a verbal interaction between the clinician and child, without the necessity for paper or plastic materials which can raise concerns about purchase, storage, distribution, and infection control. The NRS is well established with adults (Dworkin et al., 2005). However, very few studies before 2009 have reported using the NRS with children and adolescents, or have provided data supporting the use of this scale. Stinson et al. (2006), in their landmark systematic review of self-report measures, wrote: